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2023-130AD
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2023-130AD
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Last modified
12/28/2023 10:32:16 AM
Creation date
12/28/2023 10:31:14 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/20/2023
Control Number
2023-130AD
Agenda Item Number
12.D.1.
Entity Name
Ameritas Life Insurance Corp.
Subject
Administrative Service Agreement for Group Insurance for Plan Year 2023/2024
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Administrative Services Agreement <br />This Administrative Services Agreement ("Agreement") is between Indian River County ("Plan <br />Sponsor"), and Ameritas Life Insurance Corp., a Nebraska corporation ("Ameritas"), and is effective <br />upon the date set forth herein. Throughout the Agreement Ameritas and Plan Sponsor may be referred <br />to individually as "Party" or collectively as "Parties." <br />WHEREAS, Plan Sponsor has established and will administer an employee Dental benefit plan <br />("Plan") according to the Employee Retirement Income Security Act of 1974 ("ERISA") or the Public <br />Health Service Act ("PHSA"), as applicable, for its employees and their dependents; <br />WHEREAS, Plan Sponsor desires to utilize the services of Ameritas to assist in its duties to administer <br />the Plan; and <br />WHEREAS, Ameritas has agreed to provide such non -fiduciary administrative services in connection <br />with the Plan such as processing of claims and other services under the terms and conditions of this <br />Agreement. <br />NOW, THEREFORE, in consideration of the premises and mutual promises contained in this <br />Agreement, Plan Sponsor and Ameritas hereby agree as follows: <br />Section I. Scope of Agreement <br />Ameritas agrees to perform certain non -fiduciary administrative services, such as claim processing and <br />other services specified herein for the Plan, as amended, as described in Addendum A. <br />Section II. Services to be Provided by Ameritas <br />Ameritas shall perform the following administrative services in connection with the Plan: <br />A. Process claims and determine the Plan benefits applicable to Covered Employees and their <br />dependents (collectively, "Covered Persons"), including coordination of benefits, where <br />applicable, in accordance with the terms of the Plan and as specified to Ameritas by Plan <br />Sponsor, using Ameritas' claim paying system as specified to Ameritas by Plan Sponsor. <br />Ameritas will process claims incurred on or after the Effective Date of this Agreement and <br />received while this Agreement is still in effect. <br />B. Notify a Covered Person of the initial denial of a claim (benefits) and his or her right of review <br />of the denial as specified by the Plan Sponsor and in accordance with the terms of the Plan. <br />C. Issue checks in payment of benefits payable under the Plan which, subject to the terms of this <br />Agreement, shall be paid through the bank account as set forth in Section IV. of this <br />Agreement. <br />D. Answer benefits and claims questions and inquiries of Covered Persons and providers through <br />toll free telephone number. <br />E. Communicate with Plan Sponsor as is necessary to verify eligibility of Covered Persons. <br />
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